Transfusions with stabilized hemoglobin covalently bound to a nitroxide or polymers thereof

Abstract

Compositions and processes to alleviate oxygen toxicity are disclosed based on the addition of nitroxides to physiologically compatible macromolecules. In particular, hemoglobin-based red cell substitutes are described featuring stable nitroxide free radicals for use in cell-free hemoglobin solutions, encapsulated hemoglobin solutions, stabilized hemoglobin solutions, polymerized hemoglobin solutions, conjugated hemoglobin solutions, nitroxide-labelled albumin, and nitroxide-labelled immunoglobulin. The formulations described herein interact with free radicals, act as antioxidant enzyme-mimics, and alleviate oxidative stress and oxygen-related toxicity.

I claim as follows: 
     
       1. A method to treat a physiological condition requiring a blood transfusion comprising administering to a patient requiring a blood transfusion of a red cell substitute, said red cell substitute comprising stabilized hemoglobin in a physiologically compatible solution, wherein said stabilized hemoglobin is covalently bound to a nitroxide. 
     
     
       2. The method of claim 1 wherein the hemoglobin is stabilized by cross-linking. 
     
     
       3. The method of claim 1 wherein the stabilized hemoglobin is recombinant. 
     
     
       4. The method of claim 2 wherein the hemoglobin is cross-linked using a polyvalent aldehyde derived from a ring-opened linear sugar. 
     
     
       5. The method of claim 2 wherein the hemoglobin is cross-linked using a polyvalent aldehyde derived from a ring-opened cyclic sugar. 
     
     
       6. The method of claim 2 wherein the cross-linked hemoglobin comprises a polyvalent aldehyde derived from an anionic derivative of a ring-opened cyclic sugar. 
     
     
       7. The method of claim 2 wherein a succinic acid derivative of the nitroxide is used as a cross-linking agent. 
     
     
       8. The method of claim 1 wherein the nitroxide is covalently bound to a site on the hemoglobin selected from among the group consisting of a sulfhydro group, a β93 site, and a reactive amino group. 
     
     
       9. The method of claims 1, 2, 3, 4, 5, 6, 7, or 8 wherein the nitroxide is comprised of the structure ##STR9## where the alpha carbons atoms are completely substituted such that the stability of the free radical is preserved. 
     
     
       10. The methods of claim 1, 2, 3, 4, 5, 6, 7, or 8 wherein the nitroxide has the structure ##STR10## where R 1  -R 4  are alkyl groups of 1-4 carbon atoms and A is the remaining members of a 5-membered ring. 
     
     
       11. The method of claim 10 wherein the nitroxide is 2,2,5,5-tetramethylpyrrolidine-N-oxyl. 
     
     
       12. The method of claim 1, 2, 3, 4, 5, 6, 7, or 8 wherein the nitroxide has the structure ##STR11## where R 1  -R 4  are alkyl groups of 1-4 carbon atoms and A is the remaining members of a 6-membered ring. 
     
     
       13. The method of claim 12 wherein the nitroxide is 2,2,6,6-tetramethylpiperdine-N-oxyl. 
     
     
       14. A method to treat a physiological condition requiring a blood transfusion comprising administering to a patient requiring a blood transfusion of a red cell substitute, said red cell substitute comprising a polymer of stabilized hemoglobin in a physiologically compatible solution, wherein said stabilized hemoglobin is covalently bound to a nitroxide. 
     
     
       15. The method of claim 14 wherein the hemoglobin polymer comprises a polyvalent aldehyde derived from a ring-opened cyclic sugar. 
     
     
       16. The method of claim 14 wherein the hemoglobin polymer comprises a polyvalent aldehyde derived from a ring-opened cyclic sugar. 
     
     
       17. The method of claim 14 wherein the hemoglobin polymer is comprised of an anionic derivative of a ring-opened cyclic sugar. 
     
     
       18. The method of claim 15 wherein the polyvalent aldehyde is o-raffinose. 
     
     
       19. The method of claim 14 wherein the hemoglobin polymer comprises hemoglobin and glutaldehyde. 
     
     
       20. The method of claim 14 wherein the nitroxide is bound to an aldehyde group on the glutaldehyde. 
     
     
       21. The method of claims 14, 15, 16, 17, 18, 19, or 20 wherein the nitroxide has the structure ##STR12## and the alpha carbon atoms are completely substituted such that the stability of the free radical is preserved. 
     
     
       22. The method of claim 21 wherein the nitroxide has the structure ##STR13## where R 1  -R 4  are alkyl groups of 1-4 carbon atoms and A is the remaining members of a 5-membered ring. 
     
     
       23. The method of claim 22 wherein the nitroxide is 2,2,5,5-tetramethylpyrrolidine-N-oxyl. 
     
     
       24. The method of claims 14, 15, 16, 17, 18, 19, or 20 wherein the nitroxide has the structure ##STR14## where R 1  -R 4  are alkyl groups of 1-4 carbon atoms and A is the remaining members of a 6-membered ring. 
     
     
       25. The method of claim 24 wherein the nitroxide is 2,2,6,6-tetramethylpiperdine-N-oxyl.